Individual
SUSAN MARIE FEDO ROSVOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6970
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6970
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
1333
ND
235Z00000X
Speech-Language Pathologist
Primary
5815
MN
235Z00000X
Speech-Language Pathologist
770154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42707900
—
WI
05
—
ENROLLED
—
MN
Enumeration date
10/18/2006
Last updated
10/01/2014
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